Book Review: Mortality by Christopher Hitchens

Linda Rubin PhD, On April 2nd, 2014

Christopher Hitchens, a profound thinker and prolific author, writes his final book, Mortality (2012), about his life-ending illness. In describing the intimate experience of “livingly dying” with metastatic, esophageal cancer, Hitchens offers a highly personal narrative, sometimes poetic, and somewhat ironically, filled with humor. His fun and graceful use of language gives readers permission to become immersed in the essence of a terrible reality, one too morbid for many even to consider. The clever use of language such as referring to a “transparent bag of poison” (in reference to chemotherapy), “Tumortown” (to distinguish the cancer-filled world from the cancer-free world), and “strangely neuter” (in describing the unanticipated side effects of the disease and its treatments), offers a light touch to some terribly difficult content that was written at pain-filled and at times powerless moments. Reading this short yet powerful book feels like listening to a brilliant, clear-headed friend talk about meaningful concepts in down-to-earth and sophisticated ways at the same time.

Hitchens poignantly articulates moving from the world of the healthy to the world of the sick. In a comfortable way, he gives details of the many “minor horrors and humiliations” that are not typically or widely mentioned in conversations about cancer or other potentially terminal illnesses. People usually know about hair loss associated with chemotherapy (though not necessarily all aspects of it; for example, I did not know that losing nasal hairs results in a constantly runny nose), but most of the mundane, albeit dreadful, day-to-day forms of degradation are not usually discussed. Yet with powerful candor and intimacy, Hitchens finds palatable ways to describe daily realities from random sores to pointless coughing, painful rashes to numbed extremities, and acute hunger to “gut-wringing nausea,” not to mention the famous hospitals filled with well-intentioned but weak, repetitive humor and awful cuisine. Hitchens compares his excruciating treatment to the horrors of torture, an experience he fully understood having voluntarily undergone “waterboarding” for the purpose of writing about it for Vanity Fair.

Much like breast cancer’s pink ribbon culture, Hitchens describes the world of esophageal cancer as one filled with cheery smiles and encouragement to keep-those-spirits-up even in the face of terrible pain, followed by inexorable death. Likewise, he draws attention to the language of cancer treatment, which is often associated with combat; fighting the war on cancer (all types of cancer, it seems) is a concept not used with other life-threatening illnesses. “You don’t hear it about long-term sufferers from heart disease or kidney failure,” Hitchens says. Instead, he describes cancer as waging a war on him, from inside his own body. He explains his own unreasonable anthropomorphic response, giving the cancer malicious intent and characterizations such as that of a “blind, emotionless alien,” something Hitchens acknowledges cannot be true.

Consistent with his strongly held and widely known atheist perspective, Hitchens offers an utterly logical and easy to follow discussion of the inherent contradictions present for those who pray for his recovery, and for those who rejoice in prayer for his cancer, which is held up as god’s punishment. He also weaves secular thinking into his process of dying, mentioning several conundrums, such as (1) Secular friends telling him he can beat cancer…if he doesn’t, has he let them down? (2) Pious people saying that if he recovers then their prayers have been answered…”that would somehow be irritating”; and (3) The religiously devout praying for god to change this murderous plan for Hitchens somehow thinking they must “instruct god how to put it right”…as if an all-knowing, divine god would need their guidance.

In his clear and creative way, Hitchens raises ideas about living in the world of cancer, ideas worthy of thought for those of us living in the world of the healthy (at least for now). He spoke of getting tons of unsolicited advice on how to be cured: what to eat or not eat, which supplements to take or not take, how to generate the perfect mental state (e.g., ways of opening certain chakras), where to find the only really, truly helpful clinic or doctor or treatment. He told his thoughts for a short book on cancer etiquette, in which he would lay down ground rules for the healthy and for the sick, such as witty tips about what to say, how to say it, and what not to say. For instance, I could imaging him advising something like “don’t be too nebulous and dance around the fact that I have cancer, and while you’re doing that, don’t be too candid about my cancer, even if I am.”

As Hitchens declines he describes his loss of voice, both literal and metaphorical, and how this lessens his ability to express reason, humor, and to socialize. “Like health itself, the loss of such a thing [voice] can’t be imagined until it occurs.” As the ability to think and write and speak are lost, other fears emerge: the fear of losing the essence of self (in spoken and written word) and the disappearance of personality and identity. As the book neared its end, Hitchens’s emotional experiences attached to dying were increasingly present. Profound, excruciating pain becomes increasingly apparent as the book – and his life – came to a close.

As I reached the end of his book, I felt a palpable loss and sadness at the inevitable fragmenting of ideas (an experience about which the reader is warned in a publisher’s footnote) of a truly powerful thinker. And in these final, fragmented, written words, Hitchens utters a single, stand-alone phrase, perhaps to those who expect cheerfulness in the face of cancer: “Not even a race for a cure….”

Professor and Licensed Psychologist in the Counseling Psychology doctoral program at Texas Woman’s University, Linda Rubin’s clinical, teaching, and research interests focus on psychological trauma, relational violence, and the psychology of women. In previous scholarly publications, she discussed a shield of denial that human beings construct to provide psychological protection from thoughts and feelings that are too devastating to contemplate for prolonged periods of time. In her essay “Pink Ribbon Culture as a Form of Psychological Denial” she explains that while psychological self-protection is completely understandable at both the individual and cultural levels, there are moments in time when it is important, even necessary, to examine individual and cultural expectations and messages, instead of denying them. Unfortunately, pink ribbon culture may be imposing joyfulness when terror is much closer to the reality.